Guide for managing HIV patients with dyslipidemia
Focus group plans to issue periodic updates
The U.S. AIDS Clinical Trial Group (ACTG) Cardiovascular Disease Focus Group’s new guidelines for evaluating and managing dyslipidemia in HIV-infected adults acknowledge that the condition is prevalent among patients receiving antiretroviral therapy.
The guidelines were released in a preliminary version on the Internet, prior to a summer publication in the Clinical Infectious Diseases journal.
One study has shown that 47% of people on protease inhibitor therapy had lipid abnormalities.1 While researchers have yet to determine whether these higher triglycerides and cholesterol levels put HIV patients at a greater risk for heart disease, the ACTG has decided the potential risk is grave enough to warrant treatment guidelines. Plus, it’s more difficult to treat HIV patients with dyslipidemia because of potential drug interactions with their antiretroviral treatment.
Here are the ACTG’s recommendations, as released in preliminary guidelines:
• Evaluate serum lipids, including total cholesterol, HDL cholesterol, and triglycerides, after eight to 12 hours of fasting.
• If fasting triglyceride levels exceed 400 mg/ dL, then the LDL calculation may be unreliable. Intervention decisions can be based on other measurements.
• Screen patients for other risk factors, including family history, smoking, hypertension, menopausal status, physical inactivity, obesity, diabetes, excessive alcohol use, hypothyroidism, renal disease, liver disease, and hypogonadism.
• Prescribe diet and exercise to any HIV patient with fasting triglycerides of greater than 200 mg/dL. Patients with isolated hypertriglyceridemia of greater than 1000 mg/dL are candidates for drug therapy.
• For hypercholesterolemia, first institute non-drug therapies, giving these a thorough trial before beginning drug treatment. In some HIV patients, it is more important to address problems with wasting before suggesting they change their diet due to dyslipidemia.
• Lovastatin and simvastatin have potential toxicity when combined with protease inhibitors. Fluvastatin likely interacts with nelfinavir. Few drug interaction data are available on cerivastatin.
The guidelines are offered in an abbreviated version on the Internet at: http://aactg.s-3.com/ pub/docs/lipid_guidelines.htm.
References
1. National Cholesterol Education Program. Second report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II). Circulation 1994; 89:1,329-1,445.
2. Dube MP, Sprecher D, Henry WK, et al. Preliminary Guidelines for the Evaluation and Management of Dyslipidemia in HIV-Infected Adults Receiving Antiretroviral Therapy. Recommendations of the Adult ACTG Cardiovascular Disease Focus Group. Version 1.0. May 25, 2000.
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